Divine Residential Care Agency, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

DIVINE RESIDENTIAL CARE AGENCY, LLC

Practice address

506 Speedway Ave
Winona, MS 38967-1816

Phone

(901) 281-2747

Fax

(662) 470-5771

NPI assigned

Feb 7, 2014

Last updated

Feb 7, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daphaine Moore Blakes

Title

Ceo

Phone

(901) 281-2747

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391731200000",
    "number": "1457775744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7061 FOXHALL DR",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386371269",
            "telephone_number": "901-281-2747",
            "fax_number": "662-470-5771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 SPEEDWAY AVE",
            "city": "WINONA",
            "state": "MS",
            "postal_code": "389671816",
            "telephone_number": "901-281-2747",
            "fax_number": "662-470-5771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE RESIDENTIAL CARE AGENCY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-07",
        "last_updated": "2014-02-07",
        "status": "A",
        "authorized_official_last_name": "MOORE BLAKES",
        "authorized_official_first_name": "DAPHAINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "901-281-2747"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Winona, MS
• Providers in Winona, MS by specialty
• Assisted Living Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.